Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper

Abstract

The exponential growth of precision diagnostic tools, including omic technologies, molecular diagnostics, sophisticated genetic and epigenetic editing, imaging and nano‐technologies and patient access to extensive health care, has resulted in vast amounts of unbiased data enabling in‐depth disease characterization. New disease endotypes have been identified for various allergic diseases and triggered the gradual transition from a disease description focused on symptoms to identifying biomarkers and intricate pathogenetic and metabolic pathways. Consequently, the current disease taxonomy has to be revised for better categorization. This European Academy of Allergy and Clinical Immunology Position Paper responds to this challenge and provides a modern nomenclature for allergic diseases, which respects the earlier classifications back to the early 20th century. Hypersensitivity reactions originally described by Gell and Coombs have been extended into nine different types comprising antibody‐ (I‐III), cell‐mediated (IVa‐c), tissue‐driven mechanisms (V‐VI) and direct response to chemicals (VII). Types I‐III are linked to classical and newly described clinical conditions. Type IVa‐c are specified and detailed according to the current understanding of T1, T2 and T3 responses. Types V‐VI involve epithelial barrier defects and metabolic‐induced immune dysregulation, while direct cellular and inflammatory responses to chemicals are covered in type VII. It is notable that several combinations of mixed types may appear in the clinical setting. The clinical relevance of the current approach for allergy practice will be conferred in another article that will follow this year, aiming at showing the relevance in clinical practice where various endotypes can overlap and evolve over the lifetime.

Dietary management of IgE and non‐IgE‐mediated food allergies in pediatric patients

“…Food allergen labeling laws, the food allergens listed and how they appear on a food label, are governed by national bodies, and differ around the world. US food allergen labeling laws are governed by the Food and Drug Administration (FDA) via the Food Allergen Labeling and Consumer Protection Act (FALCPA); 5 in Canada by the Food…”

“…This position paper categorizes IgE-mediated FA into type 1 immediate reactions, non-IgE-mediated FA and EoE into type IVb Th2 cell-mediated reactions, and FPIES into type V epithelial diseases. 5 This review paper will focus on the nutritional impact of FA in general, and specifically, the impact of IgE-mediated FA, FPIES, EoE, and FPIAP.…”

The Role of Regulatory T Cells in Allergic Diseases: Collegium Internationale Allergologicum (CIA) Update 2024

“…Allergy represents a major health problem of increasing prevalence worldwide, significantly affecting the patients' and caregivers' quality of life, especially within the most severe phenotypes. The propensity to develop allergies is influenced by genetic risk factors, environmental factors, and lifestyle [1][2][3]. In clinical practice, the main manifestations of allergic diseases are allergic rhinitis (AR), asthma, food allergies, and atopic dermatitis (AD).…”

“…In clinical practice, the main manifestations of allergic diseases are allergic rhinitis (AR), asthma, food allergies, and atopic dermatitis (AD). Although different pheno-endotypes have been described, allergic diseases are mainly considered as a type 2-mediated inflammatory disease characterized by the production of high levels of IgE against innocuous stimuli known as allergens [1,4]. The immunological basis of allergic diseases, mediated by innate and adaptive immune responses, involves two different and consecutive stages: the sensitization phase and the re-exposure phase, the latter comprising both early acute and late events [4][5][6].…”

Diagnostic tests for progestogen hypersensitivity

“…However, although the definition may be ambiguous, the current and recently published classification of the allergy European Academy of Allergy and Clinical Immunology (EAACI) helps us understand the mechanisms of how allergic pathologies are mediated by different immunological mechanisms; Thus, the classification of allergic mechanisms is classified into four main groups: antibody-mediated reactions, cell-mediated reactions, Tissue-driven mechanism and direct response to chemicals. In this way, the panorama opens up more, and the immunological mechanisms that can be considered allergy are recognized ( 4 ).…”